title: Stereotactic body radiation therapy in centrally and superiorly located stage I or isolated recurrent non-small-cell lung cancer.
abstract: OBJECTIVE
  To evaluate the efficacy and adverse effects of image-guided stereotactic body radiation therapy (SBRT) in centrally/superiorly located non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  We delivered SBRT to 27 patients, 13 with Stage I and 14 with isolated recurrent NSCLC. A central/superior location was defined as being within 2 cm of the bronchial tree, major vessels, esophagus, heart, trachea, pericardium, brachial plexus, or vertebral body, but 1 cm away from the spinal canal. All patients underwent four-dimensional computed tomography-based planning, and daily computed tomography-on-rail guided SBRT. The prescribed dose of 40 Gy (n = 7) to the planning target volume was escalated to 50 Gy (n = 20) in 4 consecutive days.
  
  
  RESULTS
  With a median follow-up of 17 months (range, 6-40 months), the crude local control at the treated site was 100% using 50 Gy. However, 3 of 7 patients had local recurrences when treated using 40 Gy. Of the patients with Stage I disease, 1 (7.7%) and 2 (15.4%) developed mediastinal lymph node metastasis and distant metastases, respectively. Of the patients with recurrent disease, 3 (21.4%) and 5 (35.7%) developed mediastinal lymph node metastasis and distant metastasis, respectively. Four patients (28.6%) with recurrent disease but none with Stage I disease developed Grade 2 pneumonitis. Three patients (11.1%) developed Grade 2-3 dermatitis and chest wall pain. One patient developed brachial plexus neuropathy. No esophagitis was noted in any patient.
  
  
  CONCLUSIONS
  Image-guided SBRT using 50 Gy delivered in four fractions is feasible and resulted in excellent local control.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. jychang@mdanderson.org
authors.forename: Joe Y
authors.initials: JY
authors.lastname: Chang
authors.forename: Peter A
authors.initials: PA
authors.lastname: Balter
authors.forename: Lei
authors.initials: L
authors.lastname: Dong
authors.forename: Qiuan
authors.initials: Q
authors.lastname: Yang
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.forename: Melenda
authors.initials: M
authors.lastname: Jeter
authors.forename: M Kara
authors.initials: MK
authors.lastname: Bucci
authors.forename: Mary F
authors.initials: MF
authors.lastname: McAleer
authors.forename: Reza J
authors.initials: RJ
authors.lastname: Mehran
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
mesh_terms: D000328:Adult; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D009367:Neoplasm Staging; D016634:Radiosurgery / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome